Whitepaper

As the healthcare industry is becoming more demanding, providers experience growing pressure due to high costs. Although many organizations have been concentrating on the front-end patient registration or the back-end claims management, the most critical mid-revenue cycle is being overlooked, which is a huge potential for financial improvement.

The Hidden Financial Engine: Understanding the Mid-Revenue Cycle

The mid-revenue cycle is the link between the delivery of patient care and claims management since it plays the role of the critical phase during which clinical information is combined with financial data to form the entire patient encounter story. This is a white paper titled “Unpacking Success in the Mid-Revenue Cycle: 'Proven Strategies for Growth” that deepens into how optimizing these processes can make a healthcare organization’s financial health so much better.

Consider this alarming statistic: Based on the report by the National Association of Healthcare Revenue Cycle Management (NAHRI), denial rates generally vary between 10% and 15% among the U.S. healthcare providers. This means that out of 100 claims received, 10-15 are initially rejected- this is a lot of money lost and administrative burden.

Important Parts of the Mid-Revenue Cycle

Five vital components of the mid-revenue cycle, which make up the whitepaper, are comprehensively discussed in the whitepaper.

• Clinical Documentation Improvement (CDI): Ensuring that what is captured in the documentation reflects the severity of patients’ illness and services provided.
• Coding and Edits: Converting clinical documentation to billable codes and eliminating mistakes
• Charge Capture: Proper recording of all the billable services rendered to the patients
• Compliance: Compliance with regulations and guidelines to avoid penalties
• Revenue Integrity: Integration of revenue capture and prevention procedures into the operations

Critical Performance Metrics That Help Financial Success

Healthcare organizations require defined KPIs that will be used to track the efficiency in the mid-revenue cycle. In the whitepaper, there are key metrics for each component, such as:

• CDI Metrics: Query response rates, chart review per day
• Coding Performance: Accuracy rates, turnaround time, productivity of coders
• Charge Capture: Capture rate, reconciliation rate
• Compliance: Audit results, denial rates, and resolution time.
• Revenue Integrity: Net collection rate, clean claim rate, revenue leakage

Six Top Mid-Cycle Challenges and How to Fix Them

• Coding Accuracy Issues: Coding inaccuracies are among the top 3 reasons for claim denial, and coding-related denials are up to 11% of the overall claims in 2022.
• Medical Record Documentation Deficiencies: The physician-centric CDI programs could have a huge impact on the capture of the Case Mix Index and revenue performance.
• Team Quality and Accountability: Developing qualified revenue cycle teams in a shortage of staffing calls for strategic ways of recruitment, education, and collaboration.
• High-Risk Charge Capture: Specialties such as cardiology and interventional radiology are highly complicated in terms of charging situations. A survey has found that 68 per cent of revenue cycle leaders admit up to 10 percent of charges are under-coded, while 56 per cent say over half of charges are over-coded.
• Cost Management: Given that healthcare spending is set to rise to 19.6% of GDP by 2031, managing labor costs and vendor costs becomes more important.
• Charge Integrity: Making sure that charges are compliant, valid, and well-documented is a task that involves the cooperation of the entire organization and automated monitoring systems.

Optimizing the Mid-Revenue Cycle: A Five-Point Strategy

The document lists five mid-cycle optimization strategies that work:

• Skillset Focus: Constructing team expertise by strategic recruitment and partnerships
• Technology Implementation: Automation of processes with a view to eliminating errors
• Establishing Consistent Policies: Standardization of quality and consistency in departments.
• Ongoing Education: Ensuring staff maintain mid-cycle proficiency
• Continuous Performance Monitoring: Metrics tracking to find improvement opportunities

The Path Forward

As healthcare organizations continue experiencing financial pressures, the mid-revenue cycle optimization has great potential that remains untapped. The whitepaper shows how the use of best practices, minimization of turnaround time, and decrease of costs can alleviate the pressure on the revenue cycle teams and improve the financial results.

Download the full white paper to learn more in detail about mid-revenue cycle management strategies that can change your organization’s financial performance. Find out how to put to use verified solutions for clinical documentation enhancement, optimization of charge capture, coding accuracy, and denial management, all of which will drive your bottom line through the roof while remaining in compliance with regulations.